Healthcare Provider Details

I. General information

NPI: 1164464095
Provider Name (Legal Business Name): LAFOURCHE PARISH HOSPITAL SERVICE DISTRICT NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 134TH PL 3RD FLOOR NORTH
CUT OFF LA
70345-4143
US

IV. Provider business mailing address

200 W 134TH PL 3RD FLOOR NORTH
CUT OFF LA
70345-4143
US

V. Phone/Fax

Practice location:
  • Phone: 985-325-2676
  • Fax: 985-632-2680
Mailing address:
  • Phone: 985-325-2676
  • Fax: 985-632-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAD A. LAFONT
Title or Position: DIRECTOR OF PRACTICE MANAGEMENT
Credential: RN
Phone: 985-325-9300